基于老年持续性心房颤动患者左心房基质消融与后壁线性隔离消融策略的对比性研究

Comparative study of left atrial matrix ablation and posterior wall linear isolation ablation strategies in elderly patients with atrial fibrillation

目的观察老年患者持续性心房颤动左心房基质改变分布特点及导管消融术对心功能的影响,探讨双肺静脉隔离联合左心房基质改良或左心房后壁线性隔离两种导管消融术式的有效性和安全性。方法选取老年持续性心房颤动患者86例。随机化原则分为两组:采用双肺静脉隔离联合左心房基质改良导管消融术式为基质改良组(43例);双肺静脉隔离联合左心房后壁线性隔离导管消融术式为线性隔离组(43例)。两组患者术前术后均进行了超声心动图及术中左心房基质标测。术后采用门诊随访和电话随访相结合的方式持续随访12个月,观察两组患者术后空白期心律失常发生率、不良反应发生率、单次消融成功率、并发症发生率以及心功能变化情况。结果术中观察86例老年持续性心房颤动患者中有72例在左心房标测到低电压区或疤痕区。术后通过12个月随访,两组空白期心律失常发生率41.9%(基质改良组),23.3%(线性隔离组),P<0.01,差异有统计学意义;两组单次消融成功率分别为83.7%(基质改良组),60.5%(线性隔离组),P<0.01,差异有统计学意义。两组均未见严重并发症发生。术后与术前相比较两组LVEF升高,LVEDD、LVAD明显减小(P<0.05),差异有统计学意义。两组患者基线资料、导管消融术中不良反应发生率、手术时间及术后并发症发生率差异无统计学意义。结论双肺静脉隔离联合左心房基质改良或左心房后壁隔离两种导管消融术治疗老年持续性心房颤动安全性基本一致,均能有效改善心功能,而前者单次消融成功率更高,后者空白期心律失常发生率低,总体而言,老年持续性心房颤动患者双肺静脉隔离联合左心房基质改良术式有效性更好。

Objective In the present study,the changes of left atrial matrix characteristics and the effect of catheter ablation on cardiac function in elderly patients with persistent atrial fibrillation were observed.Furthermore,the application of two catheter ablation methods including circular pulmonary vein isolation combined with left atrial matrix modification or left atrial posterior wall isolation were compared by researchers in order to explore effectiveness and safety of the two methods in elderly persistent atrial fibrillation patients.Methods A total of 86 elderly patients with persistent atrial fibrillation were selected and divided into two groups using randomization principle;the pulmonary vein isolation combined with left atrial matrix modified catheter ablation method was named matrix modified group(43 cases);the pulmonary vein isolation combined with left atrial posterior wall isolation catheter ablation method was named posterior wall isolation group(43 cases).During ablation left atrial electro matrix mapping were analyzed by multipole catheter for all patients.After ablation all patients were follow-up in 12 months by cardiac color doppler ultrasound examination,ECG and Holter.The incidence of arrhythmia,serious adverse event and complications were compared between two groups.Successful rate of single ablation and blank period recurrence after ablation were observed in 12 months follow-up time.Results Through electrogram mapping of left atrium low-voltage areas or scar areas were founded in 72 cases among the 86 cases after ablation,After a 12-month follow-up,the incidence of arrhythmia in the blank period between the two groups was 41.9%(matrix modified group)and 23.3%(posterior wall isolation group),independently,P<0.01,successful rates of single ablation in the two groups were 83.7%(matrix modified group),60.5%(posterior wall isolation group),independently,P<0.01.No adverse event occurred in the two groups.After AF ablation LVEF increased,LVEDD and LVAD significantly decreased in all of the cases.There was no significant difference between the two groups in patients’characters ablation time and complications rate.Conclusion Circular pulmonary vein isolation combined with left atrial matrix modification is as safe as left atrial posterior wall isolation,and it is a simplified,personalized,and more effective ablation strategy in elderly patients with persistent atrial fibrillation.